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Posterior colpotomy for the retrieval of ovarian specimens in laparoscopy: a large case series

  • Original Article
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Gynecological Surgery

Abstract

Effective tissue retrieval techniques continue to be a challenge in laparoscopic surgery. We aimed to determine the safety and efficacy of ovarian specimen retrieval via posterior colpotomy. This is a large case series study conducted in a large district general hospital. All patients in our unit who had ovarian specimens retrieved via posterior colpotomy over a 6-year period were included for analysis. A retrospective case notes review was performed. Information was collected on patient demographics, risk of malignancy indices, radiological size of the ovarian specimen, surgical spillage, postoperative complications, hospital stay duration, final histology results, gynaeoncology multidisciplinary meeting outcomes, and the eventual outcome on further intervention and survival. The main outcome measure was complication from posterior colpotomy. The secondary outcome was intra-abdominal surgical spillage and their subsequent outcomes. A total of 240 cases of posterior colpotomy tissue retrieval were analysed. There was one case of vault infection. Of 240 cases, 194 (81 %) were achieved without surgical spill and 46/240 cases (19 %) had surgical spillage. From the group of women with surgical spillage, there were no cases of chemical peritonitis. Seven women had borderline pathology and one woman had a malignant pathology (grade 1 endometrioid adenocarcinoma). All of the women who had borderline or malignant pathology remained disease-free at 2 years from the time of initial surgery. With appropriate preoperative assessments, posterior colpotomy is a safe and effective method of ovarian specimen retrieval in laparoscopy.

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References

  1. Medeiros LRR, Rosa DD, Bozzetti MC, Fachel JM, Furness S, Garry R, et al. (2009) Laparoscopy versus laparotomy for benign ovarian tumour. Cochrane Database Syst Rev;(2):CD004751

  2. Canis M, Botchorishvili R, Manhes H, Wattiez A, Mage G, Pouly JL et al (2000) Management of adnexal masses: role and risk of laparoscopy. Semin Surg Oncol 19(1):28–35

    Article  CAS  PubMed  Google Scholar 

  3. Yuen PM, KM Y, Yip SK, Lau WC, Rogers MS, Chang AA (1997) Randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol 177(1):109–114

    Article  CAS  PubMed  Google Scholar 

  4. Fanfani F, Fagotti A, Ercoli A, Bifulco G, Longo R, Mancuso S et al (2004) A prospective randomized study of laparoscopy and minilaparotomy in the management of benign adnexal masses. Hum Reprod 19(10):2367–2371

    Article  PubMed  Google Scholar 

  5. Panici PB, Muzii L, Palaia I, Manci N, Bellati F, Plotti F et al (2007) Minilaparotomy versus laparoscopy in the treatment of benign adnexal cysts: a randomized clinical study. Eur J Obstet Gynecol Reprod Biol 133(2):218–222

    Article  PubMed  Google Scholar 

  6. Stavroulis A, Memtsa M, Yoong W (2013) Methods for specimen removal from the peritoneal cavity after laparoscopic excision. The Obstetrician & Gynaecologist 15(1):26–30

    Article  Google Scholar 

  7. Uccella S, Cromi A, Bogani G, Casarin J, Serati M, Ghezzi F (2013) Transvaginal specimen extraction at laparoscopy without concomitant hysterectomy: our experience and systematic review of the literature. J Minim Invasive Gynecol 20(5):583–590

    Article  PubMed  Google Scholar 

  8. Teng FY, Muzsnai D, Perez R, Mazdisnian F (1996) A comparative study of laparoscopy and colpotomy for the removal of ovarian dermoid cysts. Obstet Gynecol 87(6):1009–1013

    Article  CAS  PubMed  Google Scholar 

  9. Pillai R, Yoong W (2010) Posterior colpotomy revisited: a forgotten route for retrieving larger benign ovarian lesions following laparoscopic excision. Arch Gynecol Obstet 281(4):609–611

    Article  CAS  PubMed  Google Scholar 

  10. Wilson JI, Dogiparthi KK, Hebblethwaite N (2007) Laparoscopic right hemicolectomy with posterior colpotomy for transvaginal specimen retrieval. Color Dis 9(7):661

    Article  Google Scholar 

  11. Pietrabissa A, Abelli M, Spinillo A (2010) Robotic-assisted laparoscopic donor nephrectomy with transvaginal extraction of the kidney. Am J Transplant 10(12):2708–2711

    Article  CAS  PubMed  Google Scholar 

  12. Jeong SH, Lee YJ, Choi WJ, Paik WY, Jeong CY (2011) Trans-vaginal specimen extraction following totally laparoscopic subtotal gastrectomy in early gastric cancer. Gastric Cancer 14(1):91–96

    Article  PubMed  Google Scholar 

  13. Diana M, Perretta S, Wall J, Costantino FA (2011) Transvaginal specimen extraction in colorectal surgery: current state of the art. Color Dis 13(6):e104–e111

    Article  CAS  Google Scholar 

  14. Templeman CL, Fallat ME, Lam AM (2000) Managing mature cystic teratomas of the ovary. Obstet Gynecol Surv 55(12):738–745

    Article  CAS  PubMed  Google Scholar 

  15. Takeuchi K, Deguchi M, Oki Y, Takekida S (2002) Granulomatous chemical peritonitis on the ileocecum after laparoscopic surgery of an ovarian mature cystic teratoma: case report. Clin Exp Obstet Gynecol 29(3):185–186

    CAS  PubMed  Google Scholar 

  16. Prat J (2014) Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynecol Obstet 124(1):1–5

    Article  Google Scholar 

  17. Bakkum-Gamez JN, Aletti GD (2009) Influence of intraoperative capsule rupture on outcomes in stage I epithelial ovarian cancer. Obstet Gynecol 114(1):172–173

    Article  Google Scholar 

  18. Dembo AJ, Davy M, Stenwig AE (1990) Prognostic factors in patients with stage I epithelial ovarian cancer. Obstet Gynecol 75(2):263–273

    CAS  PubMed  Google Scholar 

  19. Ahmed FY, Wiltshaw E, A’Hern RP, Nicol B (1996) Natural history and prognosis of untreated stage I epithelial ovarian carcinoma. J Clin Oncol 14(11):2968–2975

    CAS  PubMed  Google Scholar 

  20. Chan JK, Tian C, Monk BJ, Herzog T, Kapp DS, Bell J (2008) Prognostic factors for high-risk early-stage epithelial ovarian cancer. Cancer 112(10):2202–2210

    Article  PubMed  Google Scholar 

  21. Obermair A, Fuller A, Lopez-Varela E, van Gorp T (2007) A new prognostic model for FIGO stage 1 epithelial ovarian cancer. Gynecol Oncol 104(3):607–611

    Article  PubMed  Google Scholar 

  22. Jacobs I, Oram D, Fairbanks J, Turner J (1990) A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. BJOG 97(10):922–929

    Article  CAS  Google Scholar 

  23. Geomini P, Kruitwagen R, Bremer GL (2009) The accuracy of risk scores in predicting ovarian malignancy: a systematic review. Obstet Gynecol 113(2–1):384–394

    Article  PubMed  Google Scholar 

  24. Manjunath AP, Sujatha K, Vani R (2001) Comparison of three risk of malignancy indices in evaluation of pelvic masses. Gynecol Oncol 81(2):225–229

    Article  CAS  PubMed  Google Scholar 

  25. Tingulstad S, Hagen B, Skjeldestad F, Onsrud M, Kiserud T, Halvorsen T, Nustad K (1996) Evaluation of a risk of malignancy index based on serum CA125, ultrasound findings and menopausal status in the pre operative diagnosis of pelvic masses. BJOG: An International Journal of Obstetrics & Gynaecology 103(8):826–831

    Article  CAS  Google Scholar 

  26. Timmerman D, Calster VB, Testa AC (2010) Ovarian cancer prediction in adnexal masses using ultrasound-based logistic regression models: a temporal and external validation study by the IOTA group. Ultrasound Obstet Gynecol 36(2):226–234

    Article  CAS  PubMed  Google Scholar 

  27. Timmerman D, Testa AC, Bourne T (2008) Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol 31(6):681–690

    Article  CAS  PubMed  Google Scholar 

  28. Calster VB, Timmerman D, Lu C, Suykens JAK, Valentin L, Amant F, Vergote I, Van Huffel S (2007) Preoperative diagnosis of ovarian tumors using Bayesian kernel-based methods. Ultrasound Obstet Gynecol 29(5):496–504

    Article  PubMed  Google Scholar 

  29. Timmerman D, Testa AC, Bourne T, Ferrazzi E, Ameye L, Konstantinovic ML, Van Calster B, Collins WP, Vergote I, Van Huffel S, Valentin L (2005) Logistic regression model to distinguish between the benign and malignant adnexal mass before surgery: a multicenter study by the International Ovarian Tumor Analysis Group. J Clin Oncol 23(34):8794–8801

    Article  PubMed  Google Scholar 

  30. Kaijser J, Sayasneh A, Hoorde VK (2014) Presurgical diagnosis of adnexal tumours using mathematical models and scoring systems: a systematic review and meta-analysis. Hum Reprod Update 20(3):449–462

    Article  PubMed  Google Scholar 

  31. Calster, B, Hoorde, K, Valentin, L, Testa, AC, Fischerova, D, Holsbeke, C, et al. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ [Internet]. BMJ Publishing Group Ltd; 2014;349:g5920. Available from: http://www.bmj.com/content/349/bmj.g5920.long

  32. Ghezzi, F, Cromi, A, Uccella, S, Bogani, G, Serati, M, Bolis, P. Transumbilical versus transvaginal retrieval of surgical specimens at laparoscopy: a randomized trial. American journal of obstetrics and gynecology. 2012; 207(2):112.e1–112.e6.

  33. Chou LY, Sheu BC, Chang DY, Huang SC, Chen SY, Hsu WC, Chang WC (2010) Comparison between transumbilical and transabdominal ports for the laparoscopic retrieval of benign adnexal masses: a randomized trial. Eur J Gynecol Reprod Biol 153(2):198–202

    Article  Google Scholar 

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Acknowledgments

This work was supported by the South Tees Hospitals NHS Foundation Trust, UK.

Author contributions

CP Lim: Project development, data collection, data analysis, video recording and editing, manuscript writing.

N Hebblethwaite: Project development, manuscript editing, and responsible lead consultant for all the cases in the series.

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Authors and Affiliations

  1. Obstetrics and Gynaecology, South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK

    Chou Phay Lim & Neil Hebblethwaite

Authors
  1. Chou Phay Lim
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  2. Neil Hebblethwaite
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Corresponding author

Correspondence to Chou Phay Lim.

Ethics declarations

This study received approval from the local Research and Development board (date of approval: 17 November 2014; South Tees Hospitals NHS Foundation Trust R&D).

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

No funding was obtained from any external sources.

Electronic supplementary material

Video 1

Posterior colpotomy no-spill technique (MP4 144,824 kb)

Video 2

Posterior colpotomy intentional spill technique (MP4 170,624 kb)

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Lim, C.P., Hebblethwaite, N. Posterior colpotomy for the retrieval of ovarian specimens in laparoscopy: a large case series. Gynecol Surg 13, 345–351 (2016). https://doi.org/10.1007/s10397-016-0982-0

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  • DOI: https://doi.org/10.1007/s10397-016-0982-0

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